City Wireless-Order Form

City Wireless - Order Form Fill out form and click submit. You will be called promptly.

Products of interest (Bell)

9200-dual HD PVR $599	6100 - HD receiver $299	5900 - non-hd PVR $299
4100 - basic receiver $99	Bell Dish 20" Dish $79.99	Bell LNB $79.99

Products of interest (Starchoice)

317 Receiver $99.99	205 Receiver $79.99	505 Receiver $199.99
530 HD PVR Receiver $699.99	Quad LNB $79.99	60 cm e-dish $99.99

Services Required

Bell Install	StarChoice Install	Point Dish - Bell
Point Dish - Starchoice	RV Install	Service Call - General

Best day/time for your install/service call? (if applicable)

Preference #1:

Preference #2:

Preference #3:

Address:

Comments:

What type of programming are you most interested in?

If new home, who is the builder?